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IOM: U.S. health ranks at the bottom among rich countries


 

Americans are dying younger and living sicker than the residents of 16 other wealthy countries, according to a report from the Institute of Medicine and the National Research Council.

While the life expectancy for Americans has been rising, with men living on average to age 75 years and women to age 80 years, the United States trails most other wealthy countries (Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom).

The United States ranked last among the 17 countries studied in life expectancy for men, with American men living about 4 years less than men in top-ranked Switzerland. Among women, the U.S. ranked 16 of 17 and life expectancy is about 5 years shorter than in top-ranked Japan.

"Quite frankly, our panel was struck by the gravity of our findings," Dr. Steven H. Woolf, chair of the panel and a professor of family medicine at Virginia Commonwealth University in Richmond, said during a Jan. 9 press briefing. "Life expectancy is shorter in Americans of all ages, young and old, up to age 75. Males and females are experiencing higher rates of disease and injury and are dying sooner than [are] similar people in other high-income countries."

Despite spending more per capita on health care than any other country, the United States also ranks at or near the bottom in infant mortality and low birth weight, injuries and homicides, teen pregnancy and sexually transmitted diseases, HIV and AIDS, drug-related deaths, obesity and diabetes, heart disease, chronic lung disease, and disability.

Health problems are more common among Americans who are poor or uninsured. But the panel also found that even healthy Americans who are insured, college educated, or have high incomes seemed to be in worse health than are similar groups in other countries.

The investigation did uncover a bit of good news: Americans have lower rates of cancer mortality, compared with the 16 other high-income countries, and better control of their blood pressure and cholesterol levels.

The panel, which examined several decades worth of historical health trends, found that the likely causes of the U.S. health deficiencies are widespread and span health systems, behaviors, social and economic conditions, and physical environments.

Specifically, likely factors include being uninsured, lack of primary care access, smoking, heavy drinking, drug abuse, and not using seat belts. But other factors, such as how communities are built around the use of cars, without places for walking and biking, may contribute to a lack of physical activity, they wrote.

"No single factor, but a combination, is likely to blame for the U.S. health disadvantage," Dr. Woolf said.

The panel recommended further research into what the other 16 countries are doing to improve their health status so that those strategies could be adapted to this country. But the panel members also warned policy makers not to wait for further research to start taking action.

"We already know what to do," Dr. Woolf said. "If we fail to act, the disadvantage will continue to worsen and our children will face shorter lives and greater rates of illness than their peers in other rich nations."

m.schneider@elsevier.com

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